Shoulder dystocia

Archived User

Shoulder dystocia

January 18, 2006 03:33 AM

I am currently 24 weeks pregnant. This is my second pregnancy. My
first delivery was a planned induction and my water broken
immediately after I arrived at the hospital. I was in labor 15 hrs
and pushed for 2 hrs of that time before my daughter was born. She
was 8 lbs 4 oz. She had a severe shoulder dystocia. She had 3
broken ribs, her arm was flaacid from the shoulder to the elbow,
and she had a facial droop. The nerve damage was, as I was told,
was related to brachial plexus damage. The damage reversed itself
and she is now 4 1/2 and is fine. The doctor is telling me that the
best way to avoid this problem is not to gain too much weight. I
have gained 13 lbs so far. I am still extremely concerned about a
normal vaginal delivery. The doctor says it is possible but he will
be extremely cautious to note how the baby is moving down and how
the labor is progressing. Should I be overly concerned from a
lamaze standpoint or is it possible that the bony structure of my
pelvis has changed enough to deliver an equally sized baby? Am I
too concerned?

Also, I frequently have braxton-hicks contractions. They occur with
even mild activity (such as walking to the car). They do resolve
with rest. Should I be concerned about this? Is this a pre-cursor
to premature labor since it occurs so readily? By: MyBabyJad

Archived User

The best and safest way to avoid (or relieve) shoulder dystocia
is to give birth on hands and knees, a technique often used by
midwives, but few obs seem to know about it. If your ob is not
willing to accomodate you in this, I strongly recommend
finding a caregiver who will.

Next, while it is possible to give birth on hands and knees with an
epidural, you will be much better off if you avoid one in terms of
mobility and your ability to push effectively.

You should also know that inducing labor for suspected big baby
does not improve outcomes and increases the cesarean rate. Go to
HenciGoer.com/resources and scroll down to "Labor
Induction: When a Big Baby Is Expected." It sounds like your ob may
suggest a cesarean either during labor or perhaps even a planned
cesarean. I recommend you download
What Every Pregnant Woman Needs to Know About Cesarean Section
so that you make an informed decision based on knowledge of the
potential risks of cesarean surgery as well as the potential
benefits.

As for weight gain, if you are a high-weight woman, you will want
to gain less weight than an average- or low-weight woman, but you
do want to gain weight throughout the pregnancy on a sensible,
nutritious diet. Regular exercise helps too, not to mention helping
build stamina.

I also recommend hiring a doula. I think all women benefit from the
practical advice and emotional support doulas provide, and their
labor companions also benefit from support. However, in your case,
I think it is especially important. Your daughter's birth must have
been very distressing to you, so you are bound to be more than
usually anxious in this labor and in need of a calming, soothing
influence. And if you aren't going to use an epidural, you will
want someone with you who is knowledgeable about comfort measures
and other strategies and techniques for coping with labor pain.

Finally, I wouldn't be too concerned about Braxton-Hicks. Most
women notice them more the second time around. Check with your care
provider on this, but I believe that as long as contractions don't
get longer, stronger, and closer together, they aren't a concern.
Also, Braxton-Hicks feel like a tightening whereas labor
contractions are crampy.

Oh, and by the way, I don't know if this is an issue, but you don't
need an episiotomy. Shoulder dystocia isn't a soft tissue problem,
so an episiotomy does nothing to make the birth easier.